Active Ensembles

Unmet Patient Medical Need:

Attitudes, sources of information on cannabis use during pregnancy, and bioethical analysis.

Proposed Products:

• Extensive literature search
• Survey of pregnant women
• Risk communication guidelines
• Manuscript and presentations
• Possible grant opportunity

Community Impact: 

The Ensemble recruited two clinicians from the 16th Street Community Health Clinic, which has a primarily Hispanic clientele, and important to the study sample.

The Ensemble leveraged the membership of 16th Street clinician members to build a relationship with this community partner; even using four MAs to test-drive a survey, and provide feedback, prior to conducting the survey at the 16th Street clinic.

The 16th Street team members recruited a Spanish/English translator to administer the survey, and a nurse case manager to provide input about the community perspectives on cannabinoid information and use during pregnancy.

As are result, the Ensemble was well situated to conduct a survey at this clinic with a total of 48 participants.

Team Lead & Members (Institution):

Fabrice Jotterand, PhD (MCW)
Matthew Dellinger, PhD (MCW)
Sarah Chilenski, PhD (Pennsylvania State University)
Francisco Enriquez, MD (Ascension)
Cecilia Hillard, PhD (MCW)
Abbey Kruper, PsyD (MCW)
Krista Lisdahl, PhD (UWM)
Karen Lupa, CNM (Ascension)
Erica Marion (MCW)
Erika Peterson, MD (MCW)
Alexandra Skeeter, MD

Unmet Patient Medical Need:

Pediatric Undiagnosed & Rare Diseases

Proposed Products:

• Publications & presentations
• International & national collaborations
• Diagnostic tools
• Wearables

Team Lead & Members (Institution):

Raul Urrutia, MD (MCW)
Donald Basel, MD (MCW)
Razelle Kurzrock, MD (MCW)
Gwen Lomberk, PhD (MCW)
Jake Luo, PhD (UWM)
Angela Mathison, PhD (MCW)
Brian Smith, PhD (MCW)
Jay Urbain, PhD (Upstream Development LLC)
James Verbsky, MD, PhD (MCW)
Brian Volkman, PhD (MCW)
Michael Zimmermann, PhD (MCW)

Unmet Patient Medical Need: 

Investigating the effectiveness of a new medical device for strengthening continence muscles.

Proposed Products: 

• Establish a REDCap database for patients with fecal incontinence.
• Advance knowledge of muscle mechanisms contributing to fecal incontinence.
• Establish muscle fatigue parameters.
• Assess the impact of Kegel exercise with anal sphincter resistance exerciser on the management of fecal incontinence.

Community Impact: 

A clinician on the team identified and invited a patient with FI to join the team. Her input revealed potential barriers for patient tolerance regarding the manometry device and the potential feasibility of project implementation. She also described her experience with FI and how it affects all aspects of her life. The patient’s input is helping motivate the team members to design a device that really helps patients.

Team Lead & Members: 

Ling Mei, MD (MCW)
Emily Davidson, MD (MCW)
Jed Calata, MD (MCW)
Pamela Gross
Sumana Koduri, MD (MCW)
Elizabeth Malak (FMLH)
Julianne Newcomer, MD (MCW)
Carrie Peterson MD, MS (MCW)
Patrick Sanvanson, MD (MCW)
Vienne Sietz (MCW)
Sheila Thierfelder (MCW)
Malia Wells (MCW)

Unmet Patient Medical Need:

Develop a biorepository to identify genetic changes unique to Multiple Myeloma and analyze effects of lifestyle interventions.

Proposed Products: 

• Evaluate lifestyle intervention to improve body composition on quality of life.
• Develop a biorepository of patient derived MM marrow samples.

Community Impact: 

“The patient advocate helped clinicians to understand several issues patients face since the diagnosis and the treatment course. The burden that they face whether it is emotional, financial, and social and how these issues can be addressed in future myeloma studies and trial design.” – Dr. Binod Dhakal, Ensemble Leader

Team Lead & Members (Institution)

Binod Dhakal, MD (MCW)
Saurabh Chhabra, MD, MS (MCW)
Jing Dong, PhD (MCW)
Anita D’Souza, MD (MCW)
Siegfried Janz, MD (MCW)
Robert Johnson
Jennifer Knight, MD (MCW)
Sridhar Rao, MD, PhD (Versiti)
Melinda Stolley, PhD (MCW)
Patricia Sheean, PhD, RDN (Loyola Chicago University)

Unmet Patient Medical Need: 

Improve outcomes for under-diagnosed NAFLD in communities by utilizing diagnostic point-of-care handheld ultrasound device.

Proposed Products: 

• Evaluate the performance and validity of the portable handheld ultrasound device as a point of care clinical evaluation tool.
• Understand patient and provider concerns and acceptability of this device in clinical practice to tailor future use in population.
• Train other patient care providers in outpatient evaluation of fatty liver using this device.
• Determine true prevalence of fatty liver disease in underserved population.

Community Impact: 

The Community Engagement Function has developed an opportunity for the study screening to be conducted at Word of Hope Ministries.

The Ensemble has reached out to two clinicians from the 16th Street Community Health Clinic (with a largely Hispanic clientele) to become members of the team and help provide input from the perspective clinicians at a community clinic that treat patients with NAFLD.

The Ensemble is investigating the possibility of using Community Health Ambassadors, which is a Community Engagement initiative. The Ensemble is interested in integrating these Ambassadors into the process of providing background on NAFLD and Informed Consent to potential participants for NAFLD screening.

Team Lead & Members (Institution):

Achuthan Sourianarayanane, MD (MCW)
Orsolya Garrison, DrPH, MPH (MCW)
Michael A. Kim, MD (MCW)
Dessie Levy, PhD, RN (MCW)
Doriel Ward, PhD, MPH (MCW)

Unmet Patient Medical Need: 

Address gaps in knowledge regarding metabolic adaptation’s relationship with weight loss.

Proposed Products: 

• Provide preliminary data for Program Project Grant to the NIH focusing on the genomic and gut microbial determinants of metabolic adaptation for obesity recurrence after bariatric surgery and calorie restriction.
• Development of diagnostic and therapeutic tests to predict patient outcomes-based microbiota profile.
• Development of new technologies to quantitate anaerobic RMR in animals and humans with potential applications for obesity, cancer, and cardiovascular research.

Community Impact:

This team works closely with “Taking Off Pounds Sensibly (TOPS),” a national organization with local chapters that helps people with weight issues, similar to Weight Watchers; The organization makes available a large database of information on their participants for the Ensemble’s research.

The Ensemble team has recruited an education coordinator at TOPS to become a member of the Ensemble, as well as a TOPS participant at a local chapter of this organization. These TOPS personnel have helped the Ensemble understand the dynamics at local chapters for the potential to carry out a future study through the organization.

Team Lead & Members (Institution):

Srividya Kidambi, MD (MCW)
Justin Grobe, PhD (MCW)
Roland James (MCW)
Carmen Jegers (TOPS Club Inc.)
Tammy Lyn Kindel, MD, PhD (MCW)
Anne Kwitek, PhD (MCW)
Lisa Morselli, MD, PhD (MCW)
Joni Williams, MD, PhD (MCW)

Unmet Patient Medical Need: 

There are significant knowledge gaps and religious/cultural challenges relating to palliative and hospice care needs for Muslim Americans and limited venues for dialogue, research, and intervention work focused on this topic.

Proposed Products:

• Literature review
• Educational seminars for clinicians and hospital leadership
• Generate a novel model for effective care delivery

Community Impact:

To develop an inclusive research team, the Ensemble recruited leadership from the Muslim Community Health Clinic, which serves the clinical, behavioral health, and health education needs of the Milwaukee area residents.

One of the leaders of the Clinic is also the convener & director of Sakina Senior Center, a Muslim community center that addresses the social, physical, emotional, and intellectual needs of the elderly.

These dual roles give this community leader keen insight into both the needs of Muslim community members and methods to address them. She has assisted in developing the ‘problem’ space and ‘solution’ space arms of the project.

Unmet Patient Medical Need: 

Insufficient tissue-based pathology studies, practical diagnostics for predicting disease progression (e.g., biomarkers) and uncertainty if those who recover from COVID-19 are at increased risk for cerebrovascular accidents, cardiac, renal or lung failure in the ensuing years.

Proposed Products:

• REDCap database to capture symptom-onset-to-death (SOTD) timelines.
• Develop and validate clinical diagnostic tool Proteostatic Stress Index (PSI)®.

Unmet Patient Medical Need: 

Critically ill children and those with complex health needs, and their families, are at risk for adverse health outcomes: sleep disruption, fatigue, and mental health issues (anxiety, trauma symptoms, and depression); youth with chronic health issues face risk of adverse emotional, behavioral, and social outcomes. Providers rely on illness severity to assess degrees of distress and to allocate supportive resources; research suggests this approach is inadequate.

Proposed Products: 

• Obtain exploratory data to understand and amplify stakeholder perspectives to best fit a solution to the problem, and to account for other contributing factors prior to piloting an intervention.
• Pilot data for a direct measurement of stress and distress among families of critically ill patients
• Development of formal educational offerings.

Unmet Patient Medical Need: 

Need for male/female equity in vehicle crash safety; current safety features are largely based on testing with male-representative dummies.

Proposed Products: 

• Characterize sex-related injury patterns in the abdomen and pelvis.
• Statistical analysis to reveal correlations between sex and injury patterns.
• Evaluate female-specific injuries and evaluate structural differences.

Community Impact: 

The Ensemble has recruited a female patient who has suffered a significant auto accident and who is also Columbia University graduate student and is studying this area of research.

Unmet Patient Medical Need: 

A need of clinically testable biological factors/pathways activated in response to environmental and social conditions and how such stressors might have biological consequences on essential stress-inducible signaling systems.

Proposed Products: 

• Development of a Precision Public Health Tool with clinical data embedded in the electronic medical records (EMR).
• Development of a risk calculator designed for personalized medical clinical integration.

Unmet Patient Medical Need: 

Because of the new and growing nature of this practice, clinicians have not yet been able to formally evaluate patient outcomes, satisfaction, quality-of-life, and the access to care within a multidisciplinary lens.

Proposed Products:

• Create a prospective database of transgender patients seeking health care at Froedtert.
• Obtain data examining the barriers that patients face, and obstacles to treatments.
• Assessment of mental health and quality-of-life, before and after treatment.

Community Impact: 

The team built a relationship with Pathways Counseling in Milwaukee, to include social workers and therapists in the Ensemble discussions. The team was also connected with a patient representative and case worker at Forge Wisconsin to provide crucial input for project design.

Unmet Patient Medical Need: 

Atrial fibrillation (AF) and hypertension (HTN) are common cardiac conditions that may be uncontrollable and asymptomatic, leading to the possibility that race contributes to the lower detection rate of AF in African Americans.

Proposed Products: 

• Community educational activities for at-risk populations.
• Community screening events using mobile EKG monitors with educational resources and clinical referrals.

Community Impact: 

“Pastor Taylor and his team were engaged, accommodating, and very helpful in the entire process.  It is obvious that they have a strong relationship with the community and the church members, and we look forward to continuing our relationship with the team and the community they serve.” – Dr. Stacey Gardiner, cardiac clinician on Ensemble team.

Unmet Patient Medical Need: 

Inability to rapidly and accurately diagnosis traumatic brain injury/concussion at the point of injury limits clinicians’ ability to accurately triage at the point of injury and correctly prognosticate short-term and long-term neurological sequelae.

Proposed Products: 

• Develop machine learning algorithm to determine presence of concussion/TBI.
• Utilizing standard 12 lead ECG to enhance algorithm effectiveness and design a point-of-care method for the diagnosis of TBI/Concussion.

Unmet Patient Medical Need: 

The need for a clinical decision aid (CDA) to be integrated into the electronic health record to assist physicians in identifying risk level for cardiovascular toxicity in cancer patients.

Proposed Products:

• Identify appropriate study cohort and data sources.
• Reproducing and running Cleveland Clinic-developed algorithm at MSOE supercomputer.
• Verifying algorithm is performing accurately and implementing into electronic health record.

Community Impact: 

A cancer survivor who is now experiencing cardiovascular disease as a product of chemotherapy is providing insight and direction for the team from not only her own experiences, but also her current work with the American Heart Association.

Unmet Patient Medical Need: 

Implementation of novel therapies to complement current interventions.

Proposed Products: 

• Determine the relationship between the use of mindfulness through Headspace and physical shoulder recovery outcome measures.
• Determine the role of mindfulness on mental health and sleep quality amongst a patient population of individuals undergoing RCR.
• Evaluate the role of cortisol in RCR patients and assess modulation of cortisol levels by mindfulness within a patient population of RCRs.

Unmet Patient Medical Need: 

Understanding COVID-19 clinical rehabilitation across different demographics.

Proposed Products: 

• Collect initial pilot data.
• Establish a COVID-19 Community Advisory Group.
• Develop and submit a NIH R01 grant application.

Unmet Patient Medical Need: 

Bidirectional interactions to reduce the influence of pregnancy-related disorders among mothers and children.

Proposed Products: 

• Establish a mechanism to engage, enroll, study, and track health outcomes of mothers beginning in the pre-pregnancy period, and continuing through gestation and beyond.
• Generate a comprehensive and cross-disciplinary toolbox.
• Provide relevant educational opportunities and preventive anticipatory guidance for women, their families, and healthcare teams.
• Track neonatal/child health outcomes.

Unmet Patient Medical Need: 

Designing yoga and exercise routines as a treatment for PTSD among veterans.

Proposed Products: 

• Analyze results from an online Qualtrics survey from a targeted N=100 Milwaukee veterans on exercise and yoga.
• Conduct a pilot feasibility study at the Athletic and Human Performance Research Center (AHPRC).

Community Impact: 

“The veteran representative provided valuable feedback on the development of our online survey by providing insight from a veteran perspective, herself. She also helped with recruitment of participants for the yoga program by sharing our recruitment flyer and through word of mouth. We believe that her being a veteran herself was helpful in her communication with veterans in the community.” – Dr. Rachel Bollaert, Ensemble Leader

Unmet Patient Medical Need: 

Disproportionate increase in the need for liver transplantation compared with the lack of available organs. Lack of therapeutic intervention to specifically address pro and anti-inflammatory/reparatory cellular integration during machine perfusion for resuscitating livers.

Proposed Products: 

• Develop a novel therapeutic approach to hepatic IRI (ischemia-reperfusion injury) using cold platelets at a time point designed to minimize inflammatory reaction and maximize tissue recovery during liver transplant.

Unmet Patient Medical Need: 

The unmet medical need is the lack of a tool to predict “time to delivery” in patients at risk of preterm birth, which would help with patient preparedness and optimize clinical care.

Proposed Products: 

• Develop markers related to “time to delivery” for all conditions leading to preterm delivery.
• Pilot longitudinal blood collections from pregnant patients to identify transcripts indicative of impending labor in healthy term pregnancies.
• Simplify the assay using machine learning and bioinformatics tools to arrive at a shorter list of discriminatory transcripts.
• Explore the potential of using transformed cell lines to report inhibition of specific predictive pathways.
• Work towards obtaining NIH funding through the preparation of a Specific Aims page for R01 submission.
• Build capacity for local longitudinal blood collections, oversampling minority women, and simplifying the assay for broader implementation.

Community Impact: 

The Ensemble has formed a partnership with the Global Alliance for Preventing Prematurity and Stillbirth (GAPPS), who provided protocols and assistance in collecting approximately 200 plasma and matched whole blood samples from pregnant subjects at a remote site through their pregnancy repository.